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Brief review: Practice variation in end of life care in the ICU: implications for patients with severe brain injury

[Revue sommaire de la variation des soins aux mourants dans les USI : implications pour les patients atteints de lésion cérébrale sévère]

Graeme M. Rocker, DM MHSc^*, Deborah J. Cook, MD MSc and Sam D Shemie, MD

^* From the Department of Medicine, Dalhousie University, Halifax, Nova Scotia; the
Departments of Medicine & Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario; and the
Division of Pediatric Critical Care, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada.

Address correspondence to: Dr. G.M. Rocker, Professor of Medicine, Dalhousie University, #4457, Halifax Infirmary, 1796 Summer St., Halifax, Nova Scotia B3H 3A7, Canada. Phone: 902-473-6611; Fax: 902-473-6202; E-mail gmrocker{at}dal.ca

Purpose: To review end of life care issues in the intensive care unit (ICU) and how practice variation might affect the ultimate outcome of acute brain injury.

Sources: Bibliographic literature search and personal files.

Findings: In Canada, 10–20% of critically ill adults die in the ICU. Many of these deaths follow acute brain injury in the setting of clinical deterioration, life support limitation and brain death. This brief review addresses some key elements of end of life care for critically ill brain injured patients, including family interactions, making survival predictions, and factors influencing decision-making about cardiopulmonary resuscitation and withdrawal of mechanical ventilation.

Conclusions: Provision of compassionate high quality end of life care should be standard of practice for brain injured and all other critically ill patients who cannot survive. Inconsistencies in end of life care may affect where, when and how patients die, the quality of their death and whether or not they are considered for organ and tissue donation.

This article has been cited by other articles:

				S. D. Shemie Brain arrest to neurological determination of death to organ utilization: the evolution of hospital-based organ donation strategies in Canada/De l'arret cerebral a la determination neurologique de la mort et a l'utilisation d'organes : l'evolution du don d'organes en milieu hospitalier au Canada. Can J Anesth, August 1, 2006; 53(8): 747 - 752. [Full Text] [PDF]